Lifespan Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

600061169B Issued in IN

Legal business name

LIFESPAN PHARMACY LLC

Practice address

9900 Westpoint Drive
Suite 100
Indianapolis, IN 46256-3358

Phone

(317) 841-0388

Fax

(317) 841-0733

NPI assigned

Oct 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathy L Headley

Title

Chairperson of the Board

Phone

(812) 961-2326

Specialties & licenses 4

Addresses

Other identifiers 5

Other names 1

• Skilled Care of Indiana LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in IN2 enrollments

Enrollment records 2

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cynthia Ann Barker, RPH

  • Pharmacist
  • Indianapolis, IN
  • NPI 1629135801
  NPD
• Michelle Lynn Beland, RPH

  • Pharmacist
  • Indianapolis, IN
  • NPI 1407442643
  NPD
• Carol J Howard, RPH

  • Geriatric Pharmacist
  • Indianapolis, IN
  • NPI 1720666001
  NPD
• Erica Lyn Wring, PHARMD, BCGP

  • Geriatric Pharmacist
  • Indianapolis, IN
  • NPI 1760068431
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1093968448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2749 EAST COVENANTER DRIVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015454",
            "telephone_number": "812-961-2326",
            "fax_number": "317-841-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 WESTPOINT DRIVE",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462563358",
            "telephone_number": "317-841-0388",
            "fax_number": "317-841-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-29",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "HEADLEY",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRPERSON OF THE BOARD",
        "authorized_official_telephone_number": "812-961-2326"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IN",
            "license": "600061169B",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117622",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "60006848A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200925240A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSR-PHARMACY",
            "identifier": "60006848B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200925240",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skilled Care of Indiana LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Long Term Care Pharmacy in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Long Term Care Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.